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General NPI Number Information
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NPI Number | 1881754950
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Entity Type | Organization
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Legal Business Name | LA BELLE PERIODONTICS INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5901 BROOKLYN BLVD #206
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City | BROOKLYN CNTR
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State | MN
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Zip | 55429-2533
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Country | US
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Telephone | 763-535-1616
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Fax | 763-535-6687
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Provider Business Mailing Address
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Address Line | 5901 BROOKLYN BLVD #206
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City | BROOKLYN CNTR
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State | MN
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Zip | 55429-2533
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Country | US
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Telephone | 763-535-1616
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Fax | 763-535-6687
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEILANI L LA BELLE
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Credential | DDS
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Telephone | 763-535-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9944
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License Number State | MN
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